AB1308 MYCOPHENOLATE FOR THE TREATMENT OF EYE INVOLVEMENT IN PATIENTS WITH BEHÇET’S SYNDROME
Authors: D. Ucar, Y. Ozyazgan, S. N. Esatoglu, E. Cerme, V. Hamuryudan, M. Melikoglu, I. Fresko, S. Yurdakul, H. Yazici, G. Hatemi
Journal: Annals of the Rheumatic Diseases (2022)

Background Experience with mycophenolate in uveitis associated with Behçet’s syndrome (BS) is limited. Objectives We aimed to report the efficacy and safety of mycophenolate mofetil (MMF) and mycophenolate sodium (MPA) in the treatment of BS uveitis. Methods All patients with panuveitis or posterior uveitis who used mycophenolate for eye involvement between 2016 and 2018 were included. Patient charts were reviewed and data on demographic features, previous immunosuppressives, concomitant therapies, ocular attacks and outcome, and adverse events were extracted. Follow up was ended on October 2021. Results We included 12 BS patients (M/W: 8/4, mean age: 35±7 years) treated with mycophenolate during a mean follow-up of 42±19 months (Table 1). All but 3 patients had bilateral eye involvement. IFX and INF-α had been discontinued due to adverse events in all patients, AZA in 10/12, and Cy-A in 7/10. Table 1. Demographic, treatment and outcome of the 12 patients Age /gender Previous therapies Remission induction or Maintenance therapy Concomitant biologic Time to ocular attack (months ) Treatment after ocular attack At the end of the follow-up MMF duration (months ) 25/M AZA,Cy-A Remission induction None 2 ADA was added ADA and MPA a were switched to INF due to further ocular attacks 38 42/W AZA,Cy-A, INF, IFX Remission induction IFX N/A N/A Still on IFX and MMF 72 37/M AZA,Cy-A, INF, IFX, ADA Remission induction ADA N/A N/A Still on ADA and MMF 27 32/M AZA Remission induction None 12 IFX was added Still on IFX and MMF 52 33/W AZA, Cy-A, INF, ADA, IFX Remission induction None N/A N/A MPA b was switched to certolizumab and MTX 5 24/M AZA Remission induction IFX N/A N/A Still on MMF and IFX was stopped due to remission 63 37/M AZA, Cy-A Remission induction None 6 IFX was added IFX and MMF were switched to INF due to further ocular attacks 41 36/W AZA,Cy-A, INF Maintenance None 2 ADA was added Still on ADA and MMF 50 36/M AZA,Cy-A, INF, IFX Maintenance IFX N/A N/A Still on IFX and MMF was stopped due to remission 17 49/W AZA,Cy-A, INF Maintenance None N/A N/A Still on MMF 39 37/M AZA, INF Maintenance None 31 Cy-A was added Still on MMF and Cy-A 38 d 31/M AZA, Cy-A, INF Maintenance None 5 IFX was added Off treatment for 2 years 38 a MMF was switched to MPA due to numbness in hands and feet, and MPA was stopped due to arthralgia. b MMF was switched to MPA due to diarrhea Seven patients were prescribed mycophenolate for remission induction. One of these patients had had his first uveitis attack while on AZA treatment due to gastrointestinal involvement. The remaining 6 patients were using other immunosuppressives and experienced relapses that led to mycophenolate use. MMF was added to a biologic agent in 2 patients (IFX and ADA) and was initiated in combination with IFX in 1 patient. These 3 patients did not experience further ocular attacks and IFX was stopped due to remission in 1 patient. In the fourth patient, MMF was switched to MPA due to numbness in hands and feet and MPA was stopped due to arthralgia. This patient did not experience ocular attacks during 5 months of MPA therapy. The remaining 3 patients had further uveitis attacks without decrease in visual acuity 2, 6, and 12 months after MMF initiation, and IFX was added in 2 patients, and ADA in 1 patient. Two of these patients were switched to INF-α due to uveitis relapses. MMF was switched to MPA for diarrhea in 1 patient. Five patients had received MMF for maintenance. One of these was using IFX when MMF was started and these 2 agents were used together. This patient discontinued MMF due to remission 17 months after MMF initiation and is still on IFX monotherapy. The second patient is still on MMF for 39 months without further ocular attacks. ADA, IFX and Cy-A were added in the remaining 3 patients due to ocular attacks 2, 5 and 31 months after MMF initiation. One of these 3 patients stopped IFX and MMF due to remission and is off treatment for 2 years. Conclusion Mycophenolate may be an alternative treatment modality in addition to biologics for patients with eye involvement who are intolerant to conventional therapies. Further data is needed to show whether it would be effective when used alone. Disclosure of Interests Didar Ucar: None declared, Yilmaz Ozyazgan: None declared, Sinem Nihal Esatoglu Speakers bureau: Sinem Nihal Esatoglu has received honorariums for presentations from UCB Pharma, Roche, Pfizer, and Merck Sharp Dohme, Emir Cerme: None declared, Vedat Hamuryudan Speakers bureau: Vedat Hamuryudan has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma, Grant/research support from: Vedat Hamuryudan has received grant/research support from Celgene., Melike Melikoglu: None declared, Izzet Fresko: None declared, Sebahattin Yurdakul: None declared, Hasan Yazici: None declared, Gulen Hatemi Speakers bureau: Gulen Hatemi has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma., Grant/research support from: Gulen Hatemi has received grant/research support from Celgene.